This article reviews lessons from 20 years of experience in development and provision of clinical preventive services at Group Health Cooperative of Puget Sound, a large health maintenance organization.
Critical factors for enhancing service include the use of a population-based epidemiologic viewpoint coupled with specific evidence-based criteria to examine issues ; involvement of practitioners in the process ; a systems approach to implementation focused on predisposing factors of the practitioners and enabling factors in the practice, organizational, and community environments ; feedback of program outcomes ; and the use of automated clinical information systems.
Outcome results from our clinical prevention efforts include a 32% decrease in late-stage breast cancer (1989 to 1990) ; 89% of 2-year-old children with complete immunizations (1994) ; decrease in adult smokers from 25% to 17% (1985 to 1994) ; and an increase in bicycle safety helmet use among children from 4% to 48% along with a 67% decrease in bicycle-related head injuries (1987 to 1992).
Systematic population-based approaches to the development and provision of clinical preventive services targeting the one-to-one level of primary care and multiple infrastructure levels of care are forging a synthesis of clinical medicine and public health approaches.
Mots-clés Pascal : Médecine préventive, Etats Unis, Prévention, Homme, Rétrospective, Amérique du Nord, Amérique
Mots-clés Pascal anglais : Preventive medicine, United States, Prevention, Human, Retrospective, North America, America
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0281509
Code Inist : 002B30A03A. Création : 01/03/1996.